![]() The patient-centred medical home (PCMH) is a model of healthcare delivery that has been implemented to address the challenge of growing urban populations with complex care needs, internationally and in Australia. However, for the IUIH to continue to respond to identified community needs, and build on these health gains, further redesign of the current system of PHC was necessary. 9 Through this and the consequent improved relational care delivered, 10 substantial gains in health outcomes have been observed. 6 Over a 10-year period, IUIH and its member services (the ‘IUIH network’) have increased service coverage to the Aboriginal and Torres Strait Islander population in the region from 16% to 45%, with the number of regular patients now just under 40 000. 9 The region is one of the most populous-being home to more than 11% of Aboriginal and Torres Strait Islander peoples-and fastest population growth areas in Australia. In 2009, in response to significant growth and geographic dispersal of Aboriginal and Torres Strait Islander peoples in the South-East region of Queensland, the Institute for Urban Indigenous Health (IUIH) was established to drive innovation in delivery of health and family wellbeing services. 8 9 Established in the 1970s, the formation of ACCHS across Australia was a political and strategic response to the health and social inequities experienced by Aboriginal and Torres Strait Islander peoples. 6 This population growth, change in the age distribution and overall health levels, has required an adaptive approach to healthcare-particularly, primary healthcare (PHC).Īboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) are holistic PHC services, delivered and governed by Indigenous peoples for Indigenous peoples. 7 Furthermore, recent global trends towards urbanisation of Indigenous peoples are also reflected in the Australian context, with rapid population growth most evident in urban settings. 5 Added to this, improvements in healthcare over the last 50 years have resulted in an increase in the number of Aboriginal and Torres Strait Islander people reaching older age as well as a booming younger population, 6 with trends projected to increase significantly over the coming decades. 4 Consequently, Aboriginal and Torres Strait Islander peoples experience high levels of both non-communicable and communicable diseases. However, these protective factors have been undermined by ongoing colonisation and resultant intergenerational trauma. Health-promoting and resilience factors-such as, connection to culture, country and community and agency 1–3 are fundamental for Aboriginal and Torres Strait Islander health and wellbeing. Specific measures of patient’s self-reported experience were developed for the study as validated culturally modified measures of self-reported patient experiences are limited. Randomisation was not feasible in this real world, primary healthcare context, where the priority for implementation of a significant system reform was site readiness, and randomisation may also be negatively perceived by the community as restricting access to the new model of care. Participatory action research which privileges Aboriginal and Torres Strait Islander worldviews, knowledge, realities and terms of reference will guide the conduct of the study. Triangulation of quantitative and qualitative data will enable examination of implementation, feasibility and acceptability of the PCMH from the perspective of health providers and patients. ![]() ![]() Prospective cohort design support data collection from intervention and standard care sites to determine the impact of the patient-centred medical homes (PCMH) on access, quality of care and health outcomes.
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